History of metabolic syndrome, hypertension, and type 2 diabetes mellitus
A 26-year-old woman, with a history of metabolic syndrome, hypertension, and type 2 diabetes mellitus, is visiting the health care provider’s office to discuss weight loss options. She reports that she has been overweight since she was a teenager and that she has tried many diets but has been unsuccessful. She is upset that she has gained 10 pounds since her last visit to her HCP. The nurse documents these findings as part of today’s assessment: Height: 5 ft 5 inches; weight 314.5 lbs (143 kg). Weight last visit was 304.2 lbs (138.3 kg). BMI: 52.3. Vital signs: Blood pressure 177/98 mm Hg, pulse 88 bpm, respirations 12 breaths/min, temperature 98.2°F (36.8°C). Waist circumference: 39.8 inches; Waist-to-hip ratio: 1.0; Reflexes 3 overall; no edema noted in the ankles. Fasting lab work reveals HDL 35 mg/dL; LDL 150 mg/dL mg/dL; total cholesterol 270 mg/dL; triglycerides 173 mg/d; blood glucose 185 mg/dL; BUN 15 mg/dL; creatinine 9 mg/dL; hemoglobin 11 g/dL; hematocrit 35%. She reports that her menstrual cycles are irregular, and she has not had a normal period for 6 months. She also reports that she tries to go on walks with her husband but can’t walk very far without getting short of breath.
1. NGN Item Type: Highlighting/Enhanced Hot Spot
Highlight the assessment findings that require follow-up by the nurse.
Rationale:
Cognitive Skill: Recognize Cues
2. NGN Item Type: Cloze
Choose the most likely options for the information missing from the statement, below, by selecting from the list of options provided.
The nurse recognizes that, based on the assessment data and patient’s history, the patient is currently at risk for complications, including __________, __________, __________, _________, and __________.
Options
Cardiovascular disease
Depression
Infertility
Liver cirrhosis
Lymphoma
Lumbar disk disease
Colorectal cancer
Rationale:
Cognitive Skill: Analyze Cues
Scenario: The patient discusses her options with her health care provider, her family and
her boyfriend, and ultimately decides to have bariatric surgery. Six months later, she undergoes Roux-en-Y gastric bypass surgical procedure. After the surgery, she is admitted to the bariatric surgery unit. She has a dressing over the abdominal wound, and has intravenous fluids infusing via a PICC line. She is awake and alert and asking for something to drink. She is awake and alert and asking for something to drink. Her pain level is 4/10 on a 10-point scale.
Image transcription text
Jejunum Duodenum
1. NGN Item Type: Extended Multiple Response
Based on the patient’s current treatment plan, the patient’s priority needs will be to prevent which of the following? Select all that apply.
_____ 1. Swallowing problems
_____ 2. Dehydration
_____ 3. Electrolyte imbalances
_____ 4. Dumping syndrome
_____ 5. Balloon deflation
_____ 6. Chronic anemia
_____ 7. Thrombus formation
_____ 8. Infection
Rationale:
Cognitive Skill: Prioritize Hypotheses
2. NGN Item Type: Extended Drag and Drop
Use an X (or drag and drop) to indicate which actions listed in the left column would be included in the plan of care for this patient.
Nursing Actions | Relevant Nursing Actions |
Offer fluids when the patient is fully awake and there are no signs of an anastomosis leak. | |
Begin fluid intake at 15 mL increments every 10 to 15 minutes, gradually increasing to an intake goal of 90 mL every 30 minutes by postop day 1. | |
Offer small drinks of fluids with ice. | |
Offer low-sugar clear liquids. | |
Administer low-dose heparin as ordered. | |
Maintain bedrest until post-operative day 2. | |
Perform active and passive range-of-motion exercises. | |
Assess the abdominal wound frequently. | |
Medicate for pain as needed. |
Rationale:
Cognitive Skill: Generate Solutions
Scenario: On postoperative day 5, the patient is preparing for discharge soon. She is now eating a low fat, full liquid diet, and has been able to walk down the hallways with the physical therapist several times a day. The abdominal incision is dry and intact, and she had a loose bowel movement yesterday. She is looking forward to leaving the hospital and her parents have said they will help her for a few weeks while she recovers.
1. NGN Item Type: Matrix
Use an X for nursing actions listed below that are Indicated (necessary), Contraindicated (could be harmful), or Nonessential (not necessary). Only one selection can be made for each nursing action.
Nursing Action | Indicated | Contraindicated | Nonessential |
Instruct the patient to transition to regular food in 2 weeks. | |||
Teach the patient to avoid foods high in carbohydrates and calorie-dense foods. | |||
Instruct the patient to keep skinfolds clean and dry. | |||
Inflate the band via the subcutaneous port as needed. | |||
Administer oral cobalamin to prevent cobalamin deficiency. | |||
Encourage the patient to use a straw for fluid intake. |
Rationale:
Cognitive Skill: Take Action
2. NGN Item Type: Extended Multiple Response
The nurse evaluates the effectiveness of actions. Which of the following findings indicate effectiveness? Select all that apply.
_____ 1. The patient has lost weight since being admitted for surgery.
_____ 2. The patient’s abdominal incision is reddened with some gaps noted at the edges.
_____ 3. The patient takes the multivitamin supplements daily.
_____ 4. The patient states that she will go to postoperative clinic visits if she does not lose weight.
_____ 5. The patient eats 6 small meals a day.
_____ 6. The patient consumes fluids with her meals.
_____ 7. The patient states that she plans to get pregnant within 4 months.
_____ 8. The patient states that she will eat slowly and stop when she feels full.
Rationale:
Cognitive Skill: Evaluate Outcomes
- Explain how to determine correct placement of a nasogastric tube for a patient during the insertion process
- What is the purpose of Salem sump versus Dobbhoff tube?